Visual plasticity and its clinical applications

Normal visual development requires: 1) environmental factors (i.e. sensory experience) and 2) molecular programs that are genetically determined. Experience determines the development and preservation of visual cortical circuitry in accordance with Hebb's principle. The molecular and genetic mechanisms that regulate visual plasticity are less known. Visual experience induces postnatal neural activity that triggers a cascade of molecular processes including release of neurotrophic factors from target neurons and genetic expression of protein synthesis, transcription factors and neurotransmitters. The continuous sensory experience induces activity-dependent tuning of synaptic connections. The present knowledge permits some manipulation of plasticity and the induction of functional changes beneficial for vision. Three areas of intervention will be discussed: 1) enhancement of visual experience for children with ocular disorders, 2) re-organization of visual cortical maps, 3) retinal and cortical implants (prostheses) and transplants.